ACE inhibition or angiotensin receptor blockade: Impact on potassium in renal failure

Bakris, George L.; Siomos, Martha Zervopoulos; Richardson, DeJuran; Janssen, İmke; Bolton, W. Kline; Hebert, Lee A.; Agarwal, Rajiv; Catanzaro, Daniel F.

doi:10.1111/j.1523-1755.2000.00381.x

Cited by 226 publications

(71 citation statements)

References 25 publications

(1 reference statement)

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“…Serum potassium concentration did not show any significant change during the entire period of AT1A administration. These results agree with the previous findings by Bakris et al, 25 in which serum potassium level did not show any significant change during administration of AT1A. Serum potassium is therefore not likely to be involved in aldosterone breakthrough.…”

Section: Discussionsupporting

confidence: 83%

Aldosterone Breakthrough During Angiotensin II Receptor Antagonist Therapy in Stroke-Prone Spontaneously Hypertensive Rats

et al. 2002

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Abstract-Aldosterone breakthrough during ACE inhibitor therapy has been reported. This study investigates changes in plasma aldosterone concentration (PAC) and its mechanism and effects on target organ damage during long-term angiotensin II type 1 (AT1) receptor antagonist (AT1A) therapy in hypertensive rats. An AT1A (candesartan, 1 mg/kg per day PO) was administered in stroke-prone spontaneously hypertensive rats from 4 weeks of age for 34 weeks. PAC was significantly decreased during the first 4 weeks but showed aldosterone breakthrough after 8 weeks of AT1A administration. Plasma angiotensin II concentration was significantly elevated, whereas no change was seen in plasma ACTH or serum potassium. The mechanism(s) of aldosterone breakthrough were investigated by giving high doses of candesartan (3 mg/kg per day PO), dexamethasone (200 g/kg per day IP), or the AT2 antagonist (PD123319, 10 mg/kg per day SC) during the last week of the 24-week AT1A treatment period. Dexamethasone and AT2 antagonist but not high-dose AT1A produced a significant decrease in PAC, with a larger decrease produced by the AT2 antagonist. To clarify the effects of the residual aldosterone, effects of coadministration of low-dose spironolactone (10 mg/kg per day SC), an aldosterone antagonist, on left ventricular hypertrophy and expression of brain natriuretic peptide mRNA were determined. Low-dose spironolactone further improved left ventricular hypertrophy and brain natriuretic peptide mRNA expression despite no additional depressor effect. These results suggest that aldosterone breakthrough occurs during long-term AT1A therapy, mainly by an AT2-dependent mechanism. Residual aldosterone may attenuate the cardioprotective effects of AT1A.

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Section: Discussionsupporting

confidence: 83%

Aldosterone Breakthrough During Angiotensin II Receptor Antagonist Therapy in Stroke-Prone Spontaneously Hypertensive Rats

et al. 2002

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“…Simply raising the dose of ARBs or ACEIs or adopting the combination of the ACEI and ARB to enhance the 156 (17) 98 (7) STOP-2 blood pressure control, the serum potassium concentration would be significantly increased which may be lethal to patients, especially when the renal function was not optimal. 33,34 Another adverse effect of high dose ACEI or ARB therapy is severe anemia, partly resulted from the reduction of angiotensin II which is known to stimulate erythropoietin in certain circumstances. 35 ACEIs or ARBs has been suggested as the first choice to control blood pressure in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao

Liu³

et al. 2016

Renal Failure

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(2016) Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis, Renal Failure, 38:6,[849][850][851][852][853][854][855][856] Background:The renoprotective effect of inhibitors of renin-angiotensin system (RAS) has been identified through placebo-controlled trials. However, the effect of calcium-channel blockers (CCBs) on renal system is still controversial. Our current meta-analysis includes available evidences to compare the effect of dihydropyridine CCBs and ACEIs or ARBs on renal outcomes and mortality. We also further investigate whether CCBs can be used in combination with inhibitors of RAS to improve the prognosis of patients with chronic kidney disease (CKD). Methods and results: Electronic databases were searched up to July 2012, for clinical randomized controlled trials, assessing the effect of dihydropyridine CCBs on the incidence of end-stage renal disease (ESRD) and all-cause mortality in contrast to ACEIs or ARBs. Eight clinical trials were included containing 25,647 participants. ESRD showed significantly higher frequency with CCBs therapy compared with ACEIs or ARBs therapy, though blood pressure was decreased similarly in both groups in every trial (OR, 1.25; 95% CI, 1.05-1.48; p ¼ 0.01). In contrast, there was no significant difference in the incidence of all-cause mortality between these two groups, though ACEIs or ARBs exhibited better renoprotective effect compared to CCBs (OR, 0.96; 95% CI, 0.89-1.03; p ¼ 0.24). Conclusions: CCBs did not increase all-cause mortality incidence in patients with CKD though they displayed weaker renoprotective, compared to ACEIs or ARBs therapy. Our results suggest the combination of a CCB and an ACEI or ARB should be a preferable antihypertensive therapy in patients with CKD, considering their higher effect in decreasing blood pressure and fewer adverse metabolic problems caused.

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“…108 The risk of hyperkalaemia with either drug class is currently unknown in haemodialysis patients. A recent report notes that the use of an ACE-I or an ARB was associated with a significantly higher risk of hyperkalaemia in ESRD patients.…”

Section: Hyperkalaemiamentioning

confidence: 99%

Review: The pharmacokinetics and pharmacodynamics of angiotensin-receptor blockers in end-stage renal disease

Sica¹,

Gehr

2002

J Renin Angiotensin Aldosterone Syst

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Angiotensin-converting enzyme (ACE) inhibitors and more recently angiotensin-receptor blockers (ARBs) have become popular therapies in the end-stage renal disease (ESRD) patient. The ability of either of these drug classes to reduce blood pressure in the ESRD patient is well accepted; however, there is considerably less information available to guide the clinician in the safe and effective use of these drugs in the ESRD patient with congestive heart failure and/or coronary artery disease. Head-to-head studies in the ESRD patient are lacking for both drug classes. Several pharmacokinetic factors can influence the selection of these drugs, including dialysability and the propensity for systemic accumulation. ACE inhibitors (ACE-Is) and ARBs are recognised as having a range of nonpressor effects that are pertinent to patients with ESRD. Such effects include their ability to decrease both thirst drive and erythropoiesis. These drug classes, though, are distinguishable by the unique adverse effect profile for ACE-Is. As is the case in patients without renal failure, ESRD patients can experience cough and, less frequently, angioneurotic oedema with ACE-Is. In the ESRD population, so-called anaphylactoid dialyser reactions can occur in conjunction with ACE-I use. The use of a drug from within the ARB class carries both less risk and permits a compound with a preferred pharmacokinetic profile -limited dialysability and minimal systemic accumulation -to be administered. These attributes would favour the increased use of ARBs in this population.

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ACE inhibition or angiotensin receptor blockade: Impact on potassium in renal failure

Cited by 226 publications

References 25 publications

Aldosterone Breakthrough During Angiotensin II Receptor Antagonist Therapy in Stroke-Prone Spontaneously Hypertensive Rats

Aldosterone Breakthrough During Angiotensin II Receptor Antagonist Therapy in Stroke-Prone Spontaneously Hypertensive Rats

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Review: The pharmacokinetics and pharmacodynamics of angiotensin-receptor blockers in end-stage renal disease

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